Op-ed by Abdallah Hussein, MSF head of mission in Burkina Faso
While COVID-19 makes headlines around the world, less visible humanitarian crises continue to deteriorate. In the villages of Burkina Faso’s eastern region, killings, abductions and looting are now a regular occurrence. This is one of the areas most affected by the armed conflict between Burkino Faso’s national security forces and various armed groups, which has seen large numbers of people displaced from their homes.
Out of sight, vulnerable communities endure enormous hardship. Amid conflict, poverty and recurrent epidemics, tens of thousands of people have limited access to basic services, including healthcare, and live in fear of violent attacks and shortages of food and water.
The coming months will be even tougher: the rainy season and the so-called ‘hunger gap’, both of which start in June, generally trigger a spike in severe malnutrition and in malaria, one of the main causes of death in the country. There has not yet been a confirmed case of the new coronavirus in the area, but it adds another layer of complexity to the already huge challenge of providing aid in such an insecure setting.
Doctors Without Borders/Médecins Sans Frontières (MSF) has been providing free-of-charge quality healthcare, water and basic relief items to people in eastern Burkina Faso since May 2019. But more needs to be done. Humanitarian assistance must be urgently scaled up to prevent more preventable deaths and suffering.
“Unknown people arrived in our village one day, and started imposing on us how to dress. They also banned all ceremonies, and they killed men and children. I fled here, to Matiakoli, with my family. We are all together, and it’s a bit crowded. We don’t have enough food either; we got sorghum once, and that’s all. We have access to medical services. I only have one concern, the coronavirus, because there is no treatment for it and it kills. That worries me. Living conditions are tough now for us, but I hope everything will improve and that we will be able to go back home.”
Humanitarian needs and psychological scars
In the past two months, a new wave of attacks against remote villages in Burkina Faso’s eastern region has uprooted thousands of families, who have fled to the towns of Gayeri and Fada. Our team has heard harrowing testimonies from survivors who suffered or witnessed extreme violence, had to walk for days to reach a safe haven, and left behind everything they owned. Many had loved ones who lost their lives in the attacks. For some, the psychological scars are deep. From January to May, our teams treated more than 5,300 patients suffering from mental health issues.
The lack of adequate shelter is worrisome, with many displaced families living in tents made of straw or plastic sheeting. Even more alarming is that many people, including the host communities, have too little clean water and food.
A health system on the edge due to conflict and shortages
After four years of violence, the healthcare system in eastern Burkina Faso is very fragile. According to the World Health Organization, more than 30 medical facilities in the area have either closed or are barely functional. Drugs and medical equipment are in short supply, often due to looting or because insecurity prevents supplies being brought in, and there is a shortage of medical staff.
Extreme violence has compelled many doctors and nurses to move to safer urban areas. In this volatile environment, emergency referrals from rural communities to specialist medical facilities can be particularly challenging. Ambulances have been attacked in the area, despite the fact that this is prohibited under International Humanitarian Law. Fear is widespread. Some people are reluctant to seek healthcare out of concern that they might be associated with one side of the conflict and could become targets for violence.
Violence hinders the provision of aid
The insecurity in eastern Burkina Faso is hampering aid efforts and poses enormous challenges in reaching some communities, especially people living in remote villages. On 16 April, for example, MSF had to cancel a visit to the village of Tawalbougou, where thousands of displaced families are sheltering, after armed men fired shots at one of our medical teams. We managed to resume our activities in the area later and were able to assist the affected communities, but this is not always the case.
It is difficult to collect information about the scale of the displacement, or to get a full picture of the mortality and health situation in certain areas. Our ability to reach the most vulnerable people is often constrained by instability and by the multitude of armed groups. As a result, thousands of people remain isolated and deprived of basic services, including healthcare.
The collateral impact of COVID-19
Burkina Faso has reported more than 800 cases of COVID-19 since the outbreak was first confirmed in the country in March. Although the eastern region has so far been spared, the risk is there and, unfortunately, the pandemic is having a negative collateral impact on our work.
We have stopped all non-essential medical services in health facilities and we have adapted certain other activities. Psychological support, for example, is now carried out remotely: over the telephone and through radio programmes and awareness-raising leaflets.
COVID-19, combined with violence, is also making vaccination campaigns more challenging. To cite an example: following a recent measles outbreak, we agreed to immunise children in Pama district. The first challenge was the safety of our teams, as the area has a history of violent incidents against health workers and ambulances. The second challenge involved the strategy itself: with mass gatherings no longer possible due to COVID-19, we had to reconfigure our usual set-up, going door-to-door rather than vaccinating the children in health centres.
We also had to ensure that all vaccination teams had personal protective equipment to minimise the risk of infection. This approach demanded significant organisation and time: it was like preparing for the control of two outbreaks simultaneously. Finally, as some households had initially resisted the measles vaccine due to rumours that it had something to do with COVID-19, our community mobilisers had to put a great deal of effort into clarifying the issue. Despite these obstacles, we managed to reach our target and vaccinate more than 40,000 children against measles.
Getting access to personal protective equipment for our staff has also been problematic, and this curtails our capacity to provide assistance. It took more than two months to receive a delivery from abroad of coveralls, face shields and similar gear. At the same time, international travel restrictions are preventing us from bringing more experienced staff into the country – from specialist doctors to midwives and logisticians.
Particularly concerning is the fact that many displaced and host communities live in precarious conditions, that medical services have reduced, and that intensive care services for severely ill patients are extremely limited. This is why it is paramount to continue stepping up preventive measures at the community level, even if it is not always straightforward. How, for example, do you implement physical distancing in an overcrowded tent? How can you wash your hands frequently when you don’t even have enough safe water to drink?
The pandemic should not overshadow other acute needs
COVID-19 is an emergency within an emergency. It is just one of many priorities and it should not drive away resources from other lifesaving medical activities.
It is essential to keep this pandemic under control and to prevent any knock-on effects, but that should not be done at the expense of other critical humanitarian initiatives. In Burkina Faso’s eastern region, COVID-19 is not necessarily people’s main concern: for thousands of displaced people and host communities, simply surviving is already hard enough.
They are afraid the rainy season will destroy their makeshift shelters; they fear hunger and thirst, rather than a virus that has not yet reached the area. Tackling the pandemic should remain a priority, but it must not overshadow other acute needs nor divert funds, staff and aid from improving living conditions for the most vulnerable people.